Have you figured out that your medical plan doesn’t cover everything? …that your out-of-pocket costs and deductibles are higher than in the past?
Well, I have! Last month, I went to the doctor for my annual physical. Based on some issues I was having, he prescribed an MRI and two sonograms.
My first thought was not my health, but “how much is that going to run me?”
My doctor is awesome because he suggested some other procedures that might also work, but they were much more expensive. I think the amazing thing is that we actually talked through options to keep the cost of my healthcare manageable.
Did you know medical pricing is NOT same from one location to the next? Fact: Medical prices can vary 300%+ between healthcare providers for the same procedure, in the same network, and within the same zip code. Click here for more on that.
It’s true! Here’s my story…
During my visit, my doctor referred me to a local imaging center and called in the order for my tests. I told him I’d be using a service to help me find best pricing in my area. He said to call in and let his nurses know if I wanted to go somewhere else – they would call in the order wherever I decided to go.
Next, I called my advocacy service and was assigned to the health advocate who would help me throughout the process. He asked me some questions about…
1) My medical plan. Why? He needed to know about my insurance plan because he would find imaging centers in my network. These would most likely be the least expensive. If you’re not familiar with how insurance networks work, click here to read an article we wrote to explain.
2) The procedure I needed. Why? The health advocate needed to research pricing on the exact procedures my doctor was prescribing. One thing I learned is that it’s important to get the exact CPT codes (Current Procedural Terminology) for your procedures from your doctor. According to the AMA, “The CPT coding system offers doctors across the country a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency.” There are thousands of CPT codes for every different type of medical procedure. With this information, your Advocate knows exactly the type of procedure you need and can research locations and pricing more accurately and efficiently.
3) Where I lived. Why? He asked how many miles I as willing to travel. This allowed him to pinpoint imaging centers in my area to narrow his search.
That was all I did - then he went to work. He had to determine the in-network providers on my plan, discover what would be covered by my plan (if anything), and review pricing for each of my procedures in a database. Once he narrowed his search, he called each in-network imaging center in my area to get current pricing. On the call, he got a sense for the customer service and “feel” of the provider. As one health advocate told me, “When we call, if the receptionist is rude or leaves us on hold forever, they don’t even make the list. We don’t want to refer our clients to providers who aren’t the best.”
The result? First, I didn’t have to do ANY of that! It would’ve taken me hours to navigate through all that work. Second, I saved money! The provider my doctor referred me to was $800. My health advocate found 2 other options. One was about $950 and one was $600. Guess where I went? That’s right! The $600 provider. And, it was a great experience: the office and techs were very nice, I didn’t wait more than 5 minutes in the waiting room after I finished my paperwork, it was a beautiful facility, and convenient to my home. When I got the final bill, it was exactly what my Advocate said it would cost. Did I mention I saved $200?
Not only did I save that amount once. Because of an ongoing condition, I have to go back every 3 months for check-ups. If I had just gone with the original provider my doctor referred me to, I would overpay by hundreds this year.
Think of all the awesome things I can buy with my savings! Or, maybe I’ll give my savings to a charity that helps kids get healthcare? Decisions, decisions…
Now it’s your turn to tell your story! Have you used a service to help you get pricing on a medical procedure? Did it help?